Brackup, Ivy Lynn
Brackup, Ivy Lynn is an individual health care provider with primary practice located at 372 Washington St. Marino Center For Integrative Health, Wellesley MA 02481. She recently has only one registered license in Other Service Providers / Contractor, which is considered as her primary health care specialty. Brackup, Ivy Lynn can be contacted via phone (781) 235-5200.Contact Information
Primary practice address
372 Washington St. Marino Center For Integrative Health
Wellesley MA 02481
Phone: (781) 235-5200
Fax: (617) 382-1101
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Contractor | 171W00000X |
Profile Details
| NPI number | 1184691891 |
|---|---|
| LBN Legal business name | Brackup, Ivy Lynn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 1st, 2006 |
| Last updated | Sep 23rd, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184691891 | NPPES |
| Massachusetts | MEDICAID | 3177190 |
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